A Rare Case of Internal Gastroduodenal Hernia Through the Fundoplication Wrap Two Years Following Laparoscopic Nissen Fundoplication for the Treatment of Gastroesophageal Reflux Disease

Patient: Female, 19-year-old Final Diagnosis: Internal gastroduodenal hernia through the fundoplication wrap Symptoms: Anorexia • epigastric pain Medication: — Clinical Procedure: Exploratory laparoscopy Specialty: Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Gastroesophageal reflux disease (GERD) is a common condition that may be refractory to medical treatment with proton pump inhibitors (PPIs). Laparoscopic Nissen fundoplication is the recommended surgical treatment for GERD and is safe and effective. This report is of a rare case of internal gastroduodenal hernia as a late complication of laparoscopic Nissen fundoplication for the management of GERD in a 19-year-old woman. CASE REPORT: A 19-year-old woman was admitted to the emergency department with a three-day history of epigastric pain, anorexia, and altered bowel habit. She had a history of GERD that was treated two years previously by laparoscopic Nissen fundoplication. On the most recent hospital admission, abdominal computed tomography (CT) showed an internal hernia of the gastroduodenal junction through the tissues used as a fundoplication wrap of the abdominal esophagus. The imaging findings were confirmed at exploratory laparoscopy, at which time surgical takedown of the fundoplication was performed. CONCLUSIONS: This report is of a rare case of gastroduodenal hernia through a fundoplication wrap two years after a Nissen fundoplication. However, clinicians should be aware of this rare diagnosis in patients with a history of Nissen fundoplication who present with acute upper gastrointestinal symptoms.